Transition/Diversion from Institutions

This document describes the State of Washington’s many resources specifically designed to facilitate the transition of nursing facility residents to less restrictive, community settings. The state also offers four funding sources for transitional services people may need when leaving a nursing facility. The document notes the specific programs, their implementation and impact.

In 1996, Vermont began to shift resources from nursing facilities to home and community-based services. To implement the legislation, several programs, new services, and policy changes were created that offered individuals more choices for long-term services. This report describes how Vermont changed its long-term care system to reduce institutional reliance by supporting people with physical disabilities and older people in the most appropriate and least restrictive environment possible.

This document describes Utah’s efforts to educate nursing home residents about community-based long-term care options. Group and individual educational sessions and assessments are conducted through organizations knowledgeable about community services. The document provides further information on the implementation of this program.

This document describes Community Choice, New Jersey’s permanent, state-operated nursing facility transition program. The program provides information about nursing home alternatives and assistance moving from nursing facilities. This program’s implementation and impact are illustrated in this document.

This document describes Colorado’s Fast Track program, which aims to improve access to home and community-based services after a hospital discharge. In this program, staff work to facilitate quick eligibility determination for hospital patients who need long-term care after discharge. The program seeks to decrease unnecessary nursing home admittance. The implementation and impact of this program are described in the document.

The purpose of this report is to compare and contrast the fiscal year (FY) 2001 Systems Change Grantees’ goals and planned activities as identified in their Grant applications submitted to CMS. This report provides a summary of the goals of the 52 FY 2001 Grantees and representative examples of the various activities they plan to implement to help them achieve these goals. The report also includes a summary of States’ views of the strengths, challenges and barriers of their LTC systems.

Of the Real Choice Systems Change grantees awarded funding under CMS’s Fiscal Year (FY) 2001 solicitation, 20 have one or more initiatives to improve the recruitment and retention of direct service workers. This report focuses on the workforce initiatives of these 20 Grantees, with an in-depth look at 7 Grantees (AR [2 grants], KY, MT, NH, NC, VT, with whom RTI conducted site visits).

The Compendium contains basic information about each of the Real Choice Systems Change Grantees. The Compendium will help you learn more about how these grants will be used to allow more people of all ages with a disability or long term illness to live and participate in their communities. Real Choice Systems Change Grantees will also find the Compendium useful to identify other Grantees with similar goals and activities. This edition of the Compendium replaces all previous editions.

Project Out is an effort within Wyoming to expand the state’s Olmstead Plan to provide the least restrictive environment for consumers with disabilities. This two page document is an overview of Wyomings plan to successfully move people from nursing facilities out to the community.

This report focuses on how to cover targeted case management for nursing facility transition activities. The report includes sample Medicaid state plan amendment language.